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View From the Other Side of the Stethoscope

As an internist and cancer survivor, Wendy S. Harpham, MD, FACP, offers a unique perspective on oncology practices.

Wednesday, November 6, 2019

Empowering Patient Handouts

You have my sympathy. You'd gone over the instructions carefully and provided a handout. Yet your patient suffered a complication due to misunderstanding or misremembering your instructions. Years ago, I vented to my medical assistant after such an episode, sharing my sadness about my patient's suffering, as well as my frustration: "My instructions were right there on the handout!" Before leaving the break room, sighing in resignation, I closed my eyes and shrugged my shoulders, my voice dropping on the last word of asking, "What more can I do?"

In retrospect, that conversation-ending rhetorical question should have been a rousing call to action. For reasons that I'll soon explain, handouts are more important now than ever before. Meanwhile, common issues can lead patients to unwittingly make mistakes with their instructions, a problem I've experienced firsthand as a patient. Let's take a closer look at some of those issues, with hope of finding ways to empower handouts, especially instruction sheets.

Part of the problem is handout fatigue. At the oncology clinic alone, along with instruction sheets, patients may receive informational handouts, insurance papers, and fliers for upcoming survivorship events. In non-medical settings, handouts are shoved in their hand as they enter stores and leave local events. They find handouts in their grocery bags and kids' backpacks.

Some patients, feeling burdened or just too busy, deep-six all handouts. Others consider doctors' handouts important and intend to read them—the instruction sheets, for sure—until those rascally papers get lost between the car seats or are forgotten in a pile of junk mail.

That's a problem. With health care increasingly shifting to the outpatient setting, the stakes keep rising for patients to understand how to take their therapies. Meanwhile, you have less face-to-face time for discussing increasingly complex diagnoses and therapies. Even in a fantasy world where you enjoy unhurried visits, your patients listen to you through the wax of fears, fatigue, pain, stress… (the list goes on). They can't always hear what you say, let alone process and remember the information.

A wise mentor said, "What you say matters less than what your patients hear." Handouts offer unique advantages that may help your patients hear you correctly. For one thing, you control every word used to convey facts, insights, tips, and instructions. You can edit out the ambiguous phrases or confusing metaphors that might pop up in conversation. For another, patients control the place and pace for processing your words, and they can replay your instructions whenever needed. Importantly, your handouts educate family members and caregivers, enabling them to support patients' efforts to comply. For these reasons and more, patient handouts play a vital role in modern patient care.

How can clinicians empower handouts? If you are crafting them yourself, use as few words as possible without omitting vital information. In fifth-grade reading level language…

  • Use inspiring titles, e.g., "Instructions for a Smooth Recovery."
  • Highlight medication instructions.
  • Provide a "why" for the "what," e.g., "To protect your esophagus, you need to avoid (list of foods)…."
  • Add drawings or photos to illustrate techniques, such as how to administer drops.
  • Include a boxed instruction to "Please call the office for questions or concerns."

 Engaging Your Patients

Optimizing the text is only a start. To help your instruction sheet stand out and to encourage patient engagement…

  • Use colored or bordered paper and/or add a medical logo.
  • Add the patient's name to the top.
  • Encourage patients to keep a binder at home for instructions.
  • Help patients take a cellphone photo of the sheet and send it to their own inbox.
  • Ask patients to read the instructional handouts before they leave.

I went back and forth about including the last bullet. You may feel you can't spare the office space or staff time. Before you nix the idea, consider how it opens an opportunity to verify patients' understanding by inviting their feedback, "What questions do you have?" (Note: Asking "Do you have any questions?" makes it too easy for patients to reflexively answer "No," without thinking).

To go a step further, ask patients to repeat back the instructions as a way to reinforce the information and uncover misunderstandings. If you're worried about offending patients, frame the exercise as a test of your handout, and not of their understanding: "I need your help knowing whether I should reword my instruction sheet."

Some physicians ask patients to sign an attestation of having read their instructions. You can leverage that documentation protecting your practice to empower your instruction sheets. Patients may take your handouts more seriously if told, "We consider understanding the information on these sheets essential to your healing, like a procedure." 

If none of those suggestions work for you, that's okay. I'll wrap up with a quick reminder to destroy copies of old handouts when you update them. And with two quick suggestions for physicians to help overcome handout fatigue. First, be strategic. If the patient is dealing with a medical challenge, save handouts regarding routine care for another time. Or, if giving more than one handout, make a big deal about the instruction sheets: "These pages matter most!"

Second, before concluding the visit, advocate for your handouts. Take a moment to urge your patients to read the handouts again at home. "We're in this together. I am giving you these handouts to help you achieve the best possible outcome. Please keep them in a place where you can always refer to them."

In the quest to improve patient outcomes, handouts have the power to clarify, amplify, and reinforce your messages—but only if patients read them. Like compliance with tests and follow-up visits, patients not reading or understanding instructions may impact outcomes adversely. You may overcome handout fatigue and empower all your handouts by presenting well-crafted instruction sheets in ways that show you care. It's worth trying. For both your patients and you, the rewards of improved compliance and strengthened clinician-patient bonds are great.