Dear Colleagues,
I never anticipated a 'turf battle' when bringing up the role of other health professionals in communicating clear language to patients. My point was to emphasize the inclusiveness necessary to provide the best information . There really is not much continuity, and a forum to address this within the medical community does not really exist. Either that, or it is not particularly effective.
I am also finding, when I mention 'health literacy', it is taken as an assault on a person's intelligence. No one should have to go to medical school to understand their medical condition or how to stay healthy. I brought nurses and other health professionals into the dialogue only to reaffirm their critical role in communicating with patients.
Janet Green

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov]On Behalf Of Dickerson, Robert
Sent: Wednesday, April 04, 2007 3:50 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 832] Re: The role of nurses!


I think we need to be careful about getting into "turf" comparisons and
disputes. All health care providers who interact with patients, provide
instruction, education, directions or patient care; whether they are
physicians, nurses, nurse practitioners, physician assistants,
pharmacists, respiratory therapists, physical therapists, speech
therapists, occupational therapists, ECG techs, Echo techs,
phlebotomists and others who I'm sure should be but are not included in
this list need to understand and be versed in clear effective
communication with patients. We should be talking about, to and on
behalf of all health care providers and support their role in health
literacy improvement.

In both my professional and personal life I have interacted with health
care providers who are excellent, indifferent and poor communicators.
Yes this includes physicians, nurses, nurse practitioners, physician
assistants, pharmacists, respiratory therapists, physical therapists and
phlebotomists (haven't worked much with ECG/Echo techs or speech and
occupational therapists).

The impression I get regarded why there is so much discussion or
emphasis of health literacy issues with physicians is that clear
communication with patients is not something that has historically been
covered well in medical school, internships or residencies (I could be
wrong). There also appears to be more research published on physician
communication issues in relation to the effect on patient adherence to
care and outcomes.

Everyone who interacts with a patient does so at a different level.
While there are certainly differences in terms of purpose and goals with
communication, there is some crossover as well. We need to support clear
communication for all health care interactions regardless. On one level
a phlebotomist who simply jabs a needle in a vein and doesn't do a good
job of explaining to the patient what to expect and what the patient
needs to do has done as big a disservice to the patient as a physician
who doesn't explain the importance of follow-up appointments to someone
with a chronic condition. Yes, the outcomes may be very different, but
the basic communication problem and perception it leaves the patient
with may be the same.

Very few health care providers work in complete isolation. What each of
use does and how we interact with a patient is to a degree dependent on
other health care providers. As such we need to work together as a
health care community, not in silos by individual professional titles.

I will close with the example from a COPD support group a respiratory
therapist colleague of mine facilitates. I first introduced health
literacy to her 2 1/2 years ago using an AMA video and other materials
prefaced with the statement that while the scenarios take place in a
physician clinic setting the communication issues are not site specific
or unique to physicians only. As a side note every group I have showed
this video to and prefaced with this statement relates very well to it,
regardless of their profession or patient care setting. She talked with
the patients in the COPD support group about health care provider
communication. The biggest issue they brought up was the inconsistency
they hear from each health care provider. "My family doctor tells me one
thing, my lung doctor tells me another, the nurse tells me something
different, the pharmacist and respiratory therapists tell me something
else...I don't know who I'm supposed to believe or what I am supposed to
do." With this group it happens to be the respiratory therapist
facilitating the support group who people feel more comfortable talking
to.

There are four possibly things (could be more) that could be happening.

1. They are all telling the patient different things because they each
are talking about different things but that is not clear to patient thus
creating confusion...a problem. 
2. They are all talking about the same thing but telling the patient
something different that is conflicting...which is also a problem.
3. They are all talking about the same thing telling the patient the
same thing only saying it differently thus creating confusion...which is
a problem as well.
4. They are all telling the patient the same thing saying it the same
way but the patient is having difficulty understanding...which is still
a problem.

Now I'm getting confused. The solution is to work together to make sure
the patient is getting clear, accurate, consistent information that is
communicated clearly. We need to consistently check for understanding
using techniques like teach back. We need to make sure all people
involved in health care interactions understand the importance of clear
communication and the role they play in that whether it be a primary of
supportive role. Unfortunately some people/professions are more
receptive to this than others and I'm not sure one profession has the
market on receptivity over the others.

Thanks,
Bob Dickerson, MSHSA, RRT
Quality Improvement Coordinator, Clinical Quality
Iowa Health - Des Moines
Des Moines, Iowa
Phone: (515) 263-5792
Fax: (515) 263-5415
E-mail: DICKERR2 at ihs.org
Website: www.ihsdesmoines.org


-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
Sent: Tuesday, April 03, 2007 11:48 AM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 830] The role of nurses!

Janet and others,

I am glad to delve more into the role of nurses. I agree that nurses are
a critical link in the clear communication chain, and that, when
compared with physicians, they play a bigger variety of roles that could
include more time for education. My sister is a nurse who counsels
patients by phone, and she notes that even nurses who have plenty of
time still presume a great deal of high-level knowledge and vocabulary
when speaking with patients. 

So yes, Janet, we should be talking about, to and on behalf of nurses
and support their role role in health literacy improvement. Anyone out
there have an example to share?

All the best,
Julie


Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> "Janet Green" <janetg at chasf.org> 04/02/07 12:56 PM >>>

Dear Colleagues,
I am new to this forum. I have no easy answers either, but am enjoying
the dialogue.
It seems to me that health teams are not just physicians. Nurse training
is more patient oriented and I don't quite understand why they have not
been included in the dialogue. Nurses, nurse practitioners, P.A.'s.
LVN's are all part of the team who should be treating the whole patient.
If we direct plain language efforts only toward physicians we are at the
tip of the iceberg. It is common for a patient to feel more comfortable
talking to a nurse than a physician.
I know that the medical community is aware this is a problem, but they
have not yet 'bought into' the concept that they are the solution. The
psychology of what you hear when you have a bad disease likely has
nothing to do with intellect. But we shouldn't have to wait until we all
get a bad diagnosis to figure this one out. And it will never be solved
if directed only at physicians.

Janet Green MSPH
Senior Health Educator
Chinese Community Health Resource Center
845 Jackson Street
San Francisco, Ca. 94133
415-677-2458

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