Peanut Butter and Patient Education

Abstract

Dr Geskey has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Do you share the anxiety a trip to the grocery store provokes in me, when confronted by the many choices? I want to try a new peanut butter, and am so overwhelmed with the variety – creamy, crunchy, extra chunky, natural, classic, reduced fat, low glycemic, and blends with honey, dark chocolate, milk chocolate… – that I long for the time when I was a child and the most complicated choice I had was choosing the arm in which to receive my immunizations. Conversely, I am frustrated with the lack of educational options we offer our patients. I recall a study in which researchers videotaped several hundred routine office visits and reported that the time spent educating patients was a little over 1 minute.1 Think about that. The years of education and experience we employ when trying to engage patients to become partners with us in managing their health distilled into 1 minute to teach about disease – its manifestations, treatment, and prevention.Besides the complaint of “not enough time,” we often use a single approach to patient education regardless of whether a parent lacks a high school education or has a PhD. Sure the educational material might be written at a 5th grade level, but where is the option for audio or video preference instead of print? Where is the assessment of self-efficacy in demonstrating adherence to treatment recommendations? These deficient educational opportunities have a profound impact on health care outcomes. Unscheduled health care visits increase, adherence to medical therapy decreases, and the overall cost of health care increases.2 Unfortunately, otherwise compassionate health care providers start using the word “noncompliant” to describe many of these patients, potentially neglecting to consider creative solutions to address adherence barriers.Validated tools that assess health literacy and patient activation exist and are efficient to administer.3,4 I have used these both in practice and research, and I am amazed at the resilience and motivation patients and families display when we identify and respond to different learning styles. I start with the question, “What is something that you want to do that your illness has prevented you from achieving?” This goal-based approach allows health care providers to understand what is important to patients and allows us to develop a practical and relevant treatment approach. For example, a teenager with asthma may not have intuitively understood the importance of achieving an optimal peak flow. However, an athletic adolescent who articulates a desire to feel well enough to play soccer can be engaged in a conversation with this motivation at the center, allowing for a partnership to help the patient reach the stated goal. Using the patient’s goal as a starting point can help you frame the peak flow meter as a tool to achieving the patient’s goal rather than an abstract measure that the patient doesn’t completely understand.A good plan also helps identify when patients may have challenges achieving adherence. For example, a child who self-administers his insulin has been invited to a birthday party where cake and ice cream will be served. Asking the family how they would manage this event gives us important information as to how well they understand their child’s disease. Additionally, the discussion illustrates that having a chronic illness doesn’t exclude participation in activities with peers, and empowers the family and patient to overcome challenges rather than avoiding the event altogether.Finally, employing the concept of “Teach Back,” asking patients or their families to repeat something that you just taught, will give instant feedback as to whether your instructions were understood. As a result, I now look forward to working with patients and families with low health literacy. The challenge is more fun and satisfying than choosing a peanut butter!