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Blog: RX for education x 3
The title of this post is straight-forward: Education, Education, Education. Just like “Location, Location, Location,” in real estate language.
In medicine, education is of paramount importance. It is not enough for the doctor to write the prescription. It is just as important to educate the patient on how to take the medication, in addition to the education about side effects.
I have meant to write this post for a long time. After about 35 years of practicing medicine, I have come to realize the importance of doctor-patient communication in the exam room and, in this regard, the importance of education.
I am reminded of this topic whenever I spot on social media the famous video clip of Dr. House asking a patient with asthma how she takes her inhaler. If I understood the scene correctly, the patient kept coming to the ER with repeated asthma attacks, after onsite treatment at every visit to the ER.
Dr. House is sitting across from the patient, who was sitting on the exam table.
Patient: “My asthma, they said they fixed it, but it didn’t make any difference at all!”
Dr. House: “Anna, we need to try twice as hard to fix it. Do you use your inhaler?”
Patient: “All the time, I go through one a week.”
Dr. House: “Are you sure you’re using it right?”
Patient: “Do I look like an idiot?”
Dr. House: “No,” with a pause, recollecting his thoughts.
Dr. House: “Why don’t you show me how your inhaler works?”
The patient picks up the inhaler from her purse and sprays one spray on each side of her neck, just like she would a perfume. The look on the face of Dr. House was incredible: Disbelief, disappointment, humor!
That was an exaggerated example from television, but is that example very far from reality?
Now, let me share few real-life examples to illustrate the importance of patient education. The first is a story I heard in a national diabetes meeting many years ago. The speaker, a distinguished diabetes expert, shared with us this story:
During her residency, she encountered a patient with new-onset type 1 diabetes. The patient was repeatedly admitted with diabetic ketoacidosis. The usual cause is missing one or more insulin injections, or intercurrent illnesses, such as infection. The patient would be hospitalized for 1 to 2 days, treated and then discharged home, only to return to the ER within 1 to 2 days. The doctor admitted her to her unit more than once prior.
At one point, after several hospitalizations and discharges, the doctor pulled a chair at the bedside and asked the patient: “How do you take the insulin shot?”
The patient answered: “Exactly like I was told.”
“Show me how,” the doctor said.
The doctor gave the woman an insulin vial, an alcohol swab and an insulin needle, asking her to inject the upcoming insulin dose by herself, rather than by the nurse. The patient drew the insulin from the vial correctly, and then paused. The doctor said, “OK, and then?”
That was when the patient asked: “Where is the orange?” The doctor was shocked!
The patient was taught at the recent initial diagnosis of her diabetes how to draw the insulin and then how to inject it. The educators in the old days used oranges to inject into, with the understanding that the orange would represent the skin. Clearly, patients will get that. But not all patients. In this case, this patient did not get it. She had thought that once the patient injects insulin in the orange, the next step was eating the orange!
That was a true story.
Clearly, something went wrong during the educational session; there was a disconnect in the educator-patient communication.
Another example was shared by colleagues from our clinic:
A patient was prescribed an insulin pen and was educated in the clinic how to use it. Then his sugars were never controlled. Luckily, the educational disconnect was discovered soon enough before severe consequences occurred. The patient would dial the insulin dose correctly, take the needle and screw it on the pen, and then apply the needle to his bare skin — but with the needle cap on. Somehow, he had thought that the insulin will go through the cap and into the skin, perhaps wondering why insulin shots are not as painful as he had anticipated. The patient and the colleagues had a chuckle about this unique unintended mishap, which ended happily.
That was another true story.
One more story I heard from one of my patients, who has had type 1 diabetes for over 30 years. On one clinic visit, she and I were discussing the importance of education and doctor-patient communication, and I did share with her the insulin-orange story. She then shared her own experience:
She was diagnosed with diabetes at age 5 years. The doctor sat down with her and her mother and began trying to explain the pathophysiology of diabetes. He said something like, “Every human being has a pancreas that makes a hormone called insulin.” She shared that she heard the word as “human bean” and it was not until later, in middle school, that she had the spelling/meaning correctly. But a more intriguing disconnect occurred when the diabetes educator was explaining the importance of exercise to her. The educator was using both hands to make a manual expression of quotation marks with the index and thumb. When she returned home and began exercising, her mom saw her and asked why she was moving her index and thumb fingers.
She said, “I am exercising.”
I expect that her mom had a chuckle at the story, and then explained to the 5-year old the misunderstanding.
That, too, was yet another true story.
These stories varied in their significance, and luckily, no serious consequences resulted.
But, how many more stories like these are occurring in various medical settings? In the clinics, in the ER, in hospital wards? And how many stories may not have happy endings?
That is why education is so important in medicine.
That is why as real estate agents continue to quote the slogan “Location, Location, Location,” we in health care should always remember our own “Education, Education, Education.”
Or, in old school fashion: Rx: Education x 3.