The type of situation Ruth describes and Andres' observations and comments in part confirm my comment last week regarding Ask Me 3 being a program that unfortunately is not used properly at times or to it's full potential. I am not questioning the work Ruth's group has done with it over the past 2 years and applaud her for her efforts. It is not easy work. Previous messages have reflected what we are up against in that physician training is in most cases not consistent with principles of clear health communication.

From my understanding Ask Me 3 was never designed to put the full responsibility of communication upon the patient. Rather it is designed to promote the health care provider and patient being partners in clear communication. Unfortunately I have heard of many cases where the only thing done with Ask Me 3 is putting brochures in waiting rooms and expecting that by doing so communication will improve. As has been clearly pointed out in many previous messages, the health care providers must be on board also. The Ask Me 3 program reinforces that in the information the Partnership for Clear Health Communication provides.

I agree with the comment Andres makes regarding the need to address insensitive doctors. Like anyone, a physician's behavior (communication techniques and skills) will not change until the individual physician finds value in it. As mentioned earlier most physicians do not receive training on clear communication. Even if that starts today in all medical schools, we still have several generations of poor communicators practicing medicine. Another unfortunate barrier that is not helping attempts to influence physician communication skills, is the reimbursement system and stress on seeing as many patients as possible. This becomes the center of focus rather than the individual patient. This is all reflective of yet another broken piece of the health care system. I can appreciate the frustrations Ruth shares. I sat in on a surgery education session last week on informed consent in which a surgery resident made the comment "Why do I need to explain everything to my patients...they should just trust me." Unfortunately is was not a good setting to engage in a debate. Physicians, however, are not the only health care providers guilty of poor communication with patients. I have seen it with nurse practitioners, physician assistants, nurses, pharmacists, therapists... On the other hand the optimist in me looks at the opportunities that continue to abound in improving health care communication.

Thanks for the opportunity to share.
Bob

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 Muro, Andres
Sent: Thursday, February 01, 2007 12:55 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 610] Re: question onpatientcommunication skills trainings

Ruth:

Ask me 3 is something that physicians should be learning too. Rather than ask me 3, we should teach doctors to tell them 3. In other words, the doctors should answer those questions even if the patients don't ask. In addition, they should use language that the patients understand. For example, they should say high blood pressure instead of hypertension. 

To me, more effective than the "ask me 3" approach is the "Did you understand the problem?-can you tell me what you understood?" approach. In other words, doctors should ask their patients if they understood what the problem is, and ask the patients to explain back what the issues are, medication regimen, etc. This is often referred to as the "teach-back" approach.

Patients should never leave the doctors office if they cannot articulate what problem they have and what they will do to improve. As you mention, some doctors only have 7.5 minutes. However, there is a strategy to address this. It doesn't have to be the doctor that does this. It could be a health educator, nurse, physician's assistance that takes on this role. 

The problem with insensitive doctors needs to be addressed. Health literacy is a problem that we all have. Health literacy is the ability to communicate about health issues verbally or through print. Just as some people don't know what hypertension means, others don't know how to say high blood pressure. It is the responsibility of the service provider to work at being able to communicate with the patient. If they cannot, they are health illiterate, and they need to work at improving this.

Andres 

-----Original Message-----
From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Davis, Ruth R (LHD-Madison Co)
Sent: Thursday, February 01, 2007 10:10 AM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 609] Re: question onpatientcommunication skills trainings

We have been promoting the use of Ask Me 3 locally for about 2 years now and it is difficult to determine how often it or similar efforts are used by the consumers. I was presenting the Ask Me 3 information at a local university's senior scholars program last week when a couple of group participants shared the following stories.

	During an office visit with a physician, a woman stated she had started writing down information the 	physician was sharing with her that she wanted to remember when she left the office. He inquired as to 	what she was writing in her notebook. When she shared back with him, she said he told her to put her 	notebook away and that he would take care of her and there was no need for her to be writing anything 	down. She also conveyed that he stated he had only 7.5 minutes to spend with her and that he did not have 	the time for her to be writing information down as they were talking. When I inquired about how she 	responded to this, she stated that she felt intimidated and stopped writing. She did not leave with any 	printed information or instructions from the visit.

	Another participant asked what was being done in medical schools related to training on communications. 	He further stated that his former physician had retired and that his current physician always seemed to 	be in a rush and was not very patient when he had questions or asked for clarification. Others in the 	group nodded their heads and several stated they experienced similar behaviors.

While I realized this is not always what individuals encounter with their primary care providers, I think it brings to light some very real situations that consumers of health care are facing when seeking information from health professionals. Many times the reality of getting health professionals to pay attention to the many issues associated with health literacy is not deemed to be a high priority. I have found it has been difficult and sometimes impossible to get on the agenda of professional groups' staff meetings to discuss health literacy (using the Ask Me 3 information) or to provide a continuing educational offering on the program. Also, health professional educational programs seldom seem to address the complex issues related to health communications to any depth in our area. 

The frustration of this reality is that we may help our consumers to be more engaged in seeking information, but if health care professionals are not receptive to this active involvement, the consumers most likely will retreat. 

Ruth R. Davis MSN, RN, CHES
Community Health Nursing Supervisor
        for Public Health Education
Madison County Health Department
1001 Ace Drive, P.O. Box 1047
Berea, KY  40403
859-228-2041
Website address:
 www.madison-co-ky-health.org



-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov]On Behalf Of Dickerson, Robert
Sent: Friday, January 26, 2007 7:35 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 603] Re: question on patientcommunication skills trainings


We have done some focused work with Ask Me 3 with some very positive results. Unfortunately I think it is a program that is not used properly at times or to it's full potential.

Thanks,
Bob

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: Friday, January 26, 2007 12:35 PM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 597] Re: question on patient communication skills trainings

Mindy,
To add to the plug for AskMe3, it is also designed to train patients as well as providers. You can find it at:
http://www.askme3.org/

Also, look at the the online videos from AMA's group: Educating Physicians on Controversies in Health http://www.ama-assn.org/ama/pub/category/15369.html 

Check this out for lots of links to other good resources: 

The Health Literacy area of the ALE Wiki:
http://wiki.literacytent.org/index.php/Health_Literacy

Good luck!

Julie

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


>>> "Zeitz, Howard" <hzeitz at uic.edu> 01/25/07 8:49 PM >>>

With regard to training for health care professionals, consider the ASK ME 3 program. It targets healthcare organizations and professionals.

With regard to patients, consider the programs from Stanford Univ (Dr.
Kate Lorig and colleagues). They include a 6 week program known as the Chronic Disease Self Management Program (CDSMP) as well as programs targeted to individuals with specific diseases (eg, HIV, arthritis, etc).

Howard J Zeitz

========================================================================
===
On Thu, January 25, 2007 12:15 pm, Mindy Domb wrote:

> Hello. I really enjoy being part of this list and having access not

only

> to some great minds and terrific resources, but participating in 

> networking that really supports our work.  This is the first time I

have

> reached out to the network. I am developing training curriculum that

is

> indirectly about patient communication skills, patient/physician 

> communication.  The training is for health and human service providers

on

> how they can better support their clients with HIV and Hepatitis C to 

> better communicators with their medical providers.

>

> I am wondering if anyone has done this kind of training before or 

> trainings on the importance of patient/physician communication, or 

> building patient communications skills , what resources, activities, 

> powerpoints were effective.

>

> Many thanks!

> Mindy Domb

>

> Mindy Domb

> Director

> HIV/viral Hepatitis Integration Programs SPHERE/The Statewide 

> Homeless/HIV Integration Project HCSM, Inc.

> 942 W. Chestnut Street

> Brockton, MA 02301 USA

> 413.256.3406

> fax: 413.256.6371

> www.hcsm.org/sphere <http://www.hcsm.org/sphere>

========================================================================
===

> Julie McKinney

> Discussion List Moderator

> World Education/NCSALL

> jmckinney at worlded.org

>

> ----------------------------------------------------

> National Institute for Literacy

> Health and Literacy mailing list

> HealthLiteracy at nifl.gov

> To unsubscribe or change your subscription settings, please go to 

> http://www.nifl.gov/mailman/listinfo/healthliteracy

> ----------------------------------------------------


Howard J Zeitz, MD
Rockford Regional Partnership for Health Literacy (RRPHL)
1601 Parkview Ave
Rockford, IL 61107
T: 815-395-5964
F: 815-395-5671

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or an agent responsible for delivering it to the intended recipient, you 
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