Reader Question

Develop system to get physicians on board

Develop rapport, then materials

Question: How do we get physicians to participate in our patient education efforts? What can be done when a physician is concerned that the patient is being given too much information? What do you do when a physician won’t allow the patient to receive the standardized information for diagnosis-specific patient education?

Answer: Before putting a plan together to create patient education materials or a program, approach physicians for their input on how to solve the problem. "Show them where the problems are and bring them some facts and figures, whether it is readmissions or the results from patient satisfaction questionnaires," says Mary Wolcott, RN, MSN, patient education coordinator at Methodist Hospital in Omaha, NE. It’s important to get the physicians’ buy-in up front, she explains.

Wolcott works with the care manager nurses on the floor who are responsible for teaching and discharge planning. They, in turn, speak with the physicians to get their informal feedback on an idea. After physicians have given their informal approval, Wolcott creates a rough draft and has the care manager nurses approach the physicians again for suggestions.

When the material is complete, Wolcott sends it to all appropriate physicians for final approval. If it is a large group, she sends it to the department chair to see if he or she can approve it, or asks if she needs to send a copy to all the physicians.

It is also important to develop a close relationship with the medical staff director, says Wolcott. Often, the director can offer advice on whom to send the materials to for approval. "There have been times when the medical director has had me send the copy to physicians I probably wouldn’t have sent it to. It is covering your bases. People want to be included. They want the opportunity for input," she explains.

At St. Joseph’s Regional Medical Center in South Bend, IN, the obstetrics department has a team of experts develop the curriculum or teaching plan before taking it to the physicians for input. "We have found that physicians are not going to sit at the table and help design curriculum. We need to develop it and then ask for their input," says Jo Wells, MS, community education coordinator at St. Joseph’s. Once a rough draft is agreed upon, the teaching plan is completed and presented to the physicians and their office staff.

Making a luncheon appointment with a physician and stopping by the office with the lunch is a good way to get your ideas heard, says Wells. However, you have to be prepared and present your ideas in a clear, concise manner because physicians don’t have much time.

"I have watched pharmaceutical reps and they can say a lot in 30 seconds. We have gotten very good at that ourselves," says Wells. (For information on developing rapport with physicians, see article on p. 8.)

Develop common ground

It is important to develop common ground and a system from which to work with physicians, says Peg Harmon, RN, BSN, patient education specialist at the Mayo Clinic in Rochester, MN. At Mayo, educators and physicians agree that the needs of the patient come first because that is the standard set by the clinic. "If education is important to patients and families, which it is, then certainly it is important to both educators and providers," says Harmon.

Once an organization has established a common vision, a partnering framework helps ensure that the patient and family will receive the appropriate resources throughout the continuum of care.

"It’s important to have a system for support and communication for all those involved in patient education. At Mayo we have a liaison system that helps us stay connected to people doing patient education," says Harmon.

The medical director sends a letter to the division chair of each clinical practice area, asking him or her to name a physician liaison for patient and health education. (To learn how to create a liaison system within your health care facility, see Patient Education Management, July 1998, pp. 85-87.)

Each patient education specialist partners with several clinical practice areas to facilitate patient education. In addition to partnering with physicians, they maintain contacts with other disciplines including dietary, physical therapy, social services, and nursing leadership.

Any party can make contact concerning education issues, such as requests for materials or initiation of a patient education program. The specialists rely on their formal liaison relationships and procedures for review of all patient education materials. The liaison relationships are posted on the medical center’s Intranet along with the database of patient education materials, says Harmon.

It is a good idea to establish a philosophy or mission statement on education that is understood by everyone who participates in the care of the patient, agrees Wells. This cuts down on a lot of the controversy about how much or how little information patients should be given.

In the OB department at St. Joseph’s, for example, the philosophy is that patients need to be given nonbiased, factual information and then be allowed to make a choice. "We believe that consumers can make good informed choices when they are given nonbiased information and that is the philosophy from which we educate," says Wells. (For information on what to do when a physician won’t allow a patient to receive standardized information, see article p. 7.)

Sources

For more information on involving physicians in the education process, contact:

Peg Harmon, RN, BSN, Patient Education Specialist, Patient and Health Education Center, Mayo Clinic, Siebens, Subway Level, Rochester, MN 55905. Telephone: (507) 284-8140. Fax: (507) 284-9849.

Jo Wells, MS, Community Education Coordinator [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.

Mary Wolcott, RN, MSN, Patient Education Coordinator, Methodist Hospital, 9303 Dodge St., Omaha, NE 68114. Telephone: (402) 354-4301. Fax: (402) 354-3155. E-mail: mwolcott@nmhs.org.