by Jo Ann LeQuang

Everybody says that patient education is important, including a lot of people who aren’t doing it. But if patient education really is so crucial and worthwhile, why is it often neglected?

It’s easy to blame the hectic atmosphere of most over-extended healthcare facilities for the reason that a lot of worthwhile activities get short shrift. But maybe with patient education, there’s something deeper going on.

An educated patient can be a challenge to the clinical team. Most clinicians who have ever had the misfortune of treating a peer or colleague know that it can be exasperating to manage a patient who is intent on diagnosing, treating, and interpreting test results himself. But even lay people with no clinical background and zero medical training can torment specialists. Think of some of the most difficult patients you’ve ever encountered; were any of them those who “knew too much”?

“Educated patients ask questions. They second-guess decisions. They come armed with papers they printed off the internet…Some even come in looking for an argument!”

High maintenance relationships

Educated patients ask questions. They second-guess decisions. They want to hear explanations and be given reasons, although sometimes they don’t fully grasp the answers provided. They demand materials to read or DVDs to watch. They come armed with papers they printed off the internet, insisting on hearing your opinions on things you’ve never seen, much less evaluated. Once you manage to give them some information, they challenge you. Some even come in looking for an argument!

The educated patient is filled with expectations, some of which the clinician is obligated to destroy. How many times has a patient come to you inspired and enthusiastic about some new drug he or she saw on TV, only to find out it is prohibitively expensive or contraindicated in his or her particular case? The TV commercial “educated” the patient and you, the clinician, destroyed their dream. When such patients get angry, they rarely tend to vent their frustration at the TV commercial or the drug company; they’re mad at their doctors and nurses.

The point is that an incomplete education can fill a person with false hope and wrong expectations.

Knowing an assortment of facts without the big picture is confusing and misleading. Most of the “educated” patients we see are those who are educated just enough to be a challenge. But even patients who have a thorough knowledge of their condition can be a handful.

Sometimes clinicians avoid soliciting patient simply because they’ve been down many rabbit trails and they just don’t have time. Some patients who have high blood pressure want to get information on heart attacks. Recently, I talked to a lady with Crohn’s disease who wanted me to tell her how electricity in the brain worked; she knew that EEGs record brain waves, so she figured the brain generated electricity. Some patients are merely “interested” in a hodge-podge of medical topics and figure their appointment time and money should buy them some general answers.

“…an incomplete education can fill a person with false hope and wrong expectations.”

Clinicians may also be weary of those patients who made them feel that they had to defend every action rather than just explain what is going on. Furthermore, sometimes explaining one thing turns up misconceptions that have to be addressed. A simple explanation can turn into a marathon re-education session.

No doubt about it, educated patients can be a pain. But…

Are educated patients a great advantage?

While most educated patients (particularly those doing their own online research) may get some mistaken notions and wrong expectations along the way, they’re generally extremely receptive to overtures made by clinicians to tell them the “right” information. The educated patient is often a sponge for new information; you don’t have to “force” educational efforts on them. Many are quite amenable to learning new things and discarding their misguided ideas as you walk them through new information.

While some patients merely politely endure your efforts to tell them the basics of what they should know, the educated person is eager to learn. Most educated patients will actually read the pamphlets you distribute or watch the DVDs you provide. If you tell them about a new website, you can almost bet they’ll go there and check it out. For educators, such people are the best possible patients.

Educated patients often come to appreciate your efforts over time. While initial encounters with educated patients may be challenging at first, educated patients with chronic conditions may come to a thorough and coherent knowledge of their treatment to the point that it becomes pleasant instead of stressful or time-consuming to discuss their therapy with them.

Physicians, in particular, should encourage the educated patient even in the early difficult days of the therapeutic relationship. If a patient thoroughly understands his diagnosis, treatment, and prognosis, it becomes much easier for a physician to discuss options with the patient.

“While some patients merely politely endure your efforts…Most educated patients will actually read the pamphlets you distribute or watch the DVDs you provide. If you tell them about a new website, you can almost bet they’ll go there and check it out.”

There was an era not so long ago when physicians approached medicine as paternal figures, dispensing the care they deemed appropriate to their patients who were not even consulted for their input, much less educated. In those days, physicians might even withhold certain information about diagnosis, prognosis, or treatment options. Fortunately, legal and cultural changes have put an end to the paternalistic doctor, but it has not entirely opened the door to the doctor-who-educates.

Team players

An educated patient is much more likely to understand his diagnosis, prognosis, treatment options, and risks of procedures than an uneducated patient. This helps the patient take a more active role in his own care, which not only can improve outcomes, it can improve the healthcare provider’s legal position if there is ever a lawsuit.

Arguably, an educated patient is more likely to be treatment-adherent. Educated patients:

• are on the lookout for side effects from medication
• can monitor their own post-procedural progress better
• can keep symptom diaries better
• may learn how to and actively monitor their own blood sugar or blood pressure
• are more “interested” in learning what they can do to improve their own health.

It can be a lot more practical to push through a busy day without bothering to explain the ECG to Mr. Brown or the possible side effects of an ACE inhibitor to Mrs. Jones. So, do we really want educated patients? Although we don’t always embrace the idea (and the hard work) that goes into educating them, I think we do, resoundingly so.