Using Verbal Instruction

The most common form of patient education lies in talking to patients within the context of routine physician-patient contacts. This interaction serves as the foundation for further education that may be provided in the form of printed materials, video materials, classes, or other instructional modalities. Information must be given in a relevant way, embedded in expectations that are shared between provider and patient.

An atmosphere of acceptance, but not necessarily approval, is the first prerequisite to effective communication. This implies that the physician maintain a nonjudgmental stance when inquiring about the patient's experiences, beliefs, and behaviors. Physicians must demonstrate that they understand the patient's perspective, even if they do not agree with it. These crucial steps lead to a teaming with the patient toward achievement of common goals.

Medical jargon should be avoided. One approach to helping patients decode the jargon is to embed synonyms in the information provided; for example, "There is an atherosclerotic lesion or blockage in one of the coronary arteries, the blood vessels that carry blood to the heart muscle itself."

Specificity and clarity are equally important principles. It is best not to use language such as, "Cut down on the fat you eat," "Exercise more," "Avoid heavy lifting," or even "Take your medicine three times each day." In the case of exercise, for example, the physician can indicate the type of exercise, how often to do it, how long to do it, how intensely to do it (e.g., by using a target pulse), and how to warm up and cool down before and after, as well as any warning symptoms. This level of specificity helps to ensure that a motivated patient will have the necessary information to change behavior effectively.

A final tip for effective verbal instruction is to keep checking the patient's understanding of the information. At a minimum, patients should be encouraged to ask questions and seek clarification. A better strategy is to ask patients to summarize their understanding of the information they have been given. Questions are most effectively stated in a way that accepts blame for any misunderstandings and is therefore not condescending: "Just so I can be sure that I've been clear about the information I've given you, would you repeat back to me in your own words what you are to do?" (Falvo, 2004).

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