Handout for my patients? No way!

How to overcome physician resistance

What do you do if physicians won’t allow their patients to receive the standardized information for diagnosis-specific patient education? Provide a method for the physician to create personalized instructions, advises Mary Wolcott, RN, MSN, patient education coordinator at Methodist Hospital in Omaha, NE.

Every physician can create what the hospital calls a personal order set, which are instructions for a specific diagnosis such as a lung infection. These instructions are entered into the computer, and physicians simply write instructions for the nurse to give the patient information from their personal order set.

When the nurse enters the doctor’s name on the computer, a list of his or her personal order sets appear on the computer screen and the nurse prints off the correct one. "The physician has to order the special instructions. It is treated as a doctor’s order," says Wolcott.

Certain policies for education have been established at Methodist Hospitals of Memphis (TN) that permit nurses to initiate certain education processes without a physician’s order, says Denise Thornton, RN, MSN, CDE, patient education coordinator at the hospital system.

For example, if a patient is confused about a diet, the dietitian can be called to educate the patient without the doctor’s permission. In the cancer care area, all breast cancer patients are referred to a program called Reach to Recovery following surgery. If a physician does not want a referral to take place, he or she needs to write an order, says Thornton.

Also, on many high-volume diagnoses, preprinted physician orders have been created. These orders might state that the patient will see a cardiac educator, receive education from a dietitian, and go to cardiac rehab, for example. The physician must sign the order to initiate the education process and at that time he or she can delete or change the information, says Thornton.

"We don’t have any standardized orders, they are simply preprinted because that is almost the common practice of the physicians consistently with this particular diagnosis," explains Thornton.

While the obstetrics department at St. Joseph’s Regional Medical Center in South Bend, IN, has standardized material, it is often tailored to what each physician wants his or her patient to know, says Eileen Humes, RN, BSN, LCCE, an obstetrics nurse. For example, each physician has an opinion on when a woman should come to the hospital when she is in labor.

If one physician does not want a standardized sheet given to a patient, speak to her in private to see how she would like the information given to the patient. By discussing the matter with the physician you might be able to persuade her, says Jo Wells, MS, community education coordinator at St. Joseph’s.

Educators must try to move patients from a stage where they are no longer just contemplating a behavior change but willing to take action, the same often is true for physicians, says Susan Karlins, MPH, director of health education of Santa Clara Family Health Plan and Valley Health Plan in San Jose, CA.

A patient education manager might have to work with a physician to uncover the barrier and overcome it. "Maybe they have thought about it but aren’t sure that it won’t interfere with their communication. Or maybe they had a bad experience where misinformation was given to their patient. Patient education managers must figure out the barrier of an individual provider," says Karlins.

A small pilot study showing the benefits of a handout to the patients might help persuade physicians, says Wolcott. Several years ago, when physicians refused to let nurses give their patients medication instruction sheets because they were fearful that patients would be given the wrong one, Wolcott did a two-month trial study in the emergency department.

The nurses gave the patients instructions on any medication they were sent home with from the emergency department. "We tracked the patient satisfaction with the medication instructions and came up with 98%," she says.

Wolcott was able to show the medical director that patients were satisfied and there had been no problem with patients receiving the wrong sheet. The medical director gave her permission to have the medical education committee, which includes a physician from every department, review the sheets for approval.

Because the hospital uses a computer system that has 5,000 medication sheets, Wolcott selected the top 20 drugs to send to the committee for review, making others available on request.

"If you really focus on the patient satisfaction or patient’s comments, it is persuasive," says Wolcott.


For more information on overcoming physician barriers to patient education, contact:

Eileen Humes, RN, BSN, LCCE, Obstetric Nurse, [c/o Joanne Weaver, RN, MSN, CNSN, Patient Education Coordinator], St. Joseph’s Regional Medical Center, South Bend Campus, 801 East La Salle, South Bend, IN 46617. Telephone: (219) 237-7643. Fax: (219) 239-4032. E-mail: weaverj@sjrmc.com.

Susan Karlins, MPH, Director of Health Education, Santa Clara Family Health Plan and Valley Health Plan, 3003 Moorpark Ave., San Jose, CA 95128. Telephone: (408) 885-4038. Fax: (408) 885-5921

Denise Thornton, RN, MSN, CDE, Patient Education Coordinator, Methodist Hospitals of Memphis, 251 South Claybrook, Methodist School of Nursing, Memphis, TN 38104. Telephone: (901) 726-8435. Fax: (901) 726-8638.